Prevention of falls and harm from falls at SMHS

South Metropolitan Health Service (SMHS) promotes a culture of zero harm, including zero harm from falls.

About falls

An older woman completes some paperwork. An older man sits next to her, with a walking frame in front of him.Each year nearly one quarter of people over 60 years of age will experience a fall. For some people, the injuries caused by their fall may be so serious that they can no longer live independently.

Falls account for over 80 per cent of all injury-related hospital admissions for people aged 65 years and older. They can occur at any age, but the frequency and severity of falls-related injuries increases significantly with age and frailty.

Falls are one of the most frequently reported clinical incidents in hospitals worldwide and are associated with increased:

  • length of hospital stay
  • care and use of health resources
  • discharge rates to a nursing home or residential care facility.
Measuring falls

The World Health Organization (WHO) defines a fall as an event which results in a person coming to rest accidentally on the ground, floor or other lower level. This definition covers all types of falls-related clinical incidents, including:

  • near-misses
  • intercepted falls where the patient is lowered to the ground
  • suspected/unwitnessed slips/trips/falls
  • witnessed slips/trips/falls.

Falls are measured as a rate of falls using the number of falls-related clinical incidents divided by the number of beds occupied by patients each day (occupied bed days).

Benchmark rates

Fall rates of 4–12 per 1,000 bed days during healthcare have been described in patients 65 years and older.

In certain hospital settings, such as rehabilitation, more than 40 per cent of patients with specific clinical problems experience 1 or more falls during their admission. Of these falls, 30 per cent result in injuries.

SMHS promotes a safety culture of zero harm, including zero harm from falls. 

As there is currently no national or state agreed falls rate benchmark, SMHS sites and services use the Australian Council for Healthcare Standards (ACHS) annual peer rate as the benchmark. The ACHS annual peer rate provides a comparison based on a yearly average across all Australia/New Zealand organisations participating in the ACHS Clinical Indicator Program. The most recently published ACHS annual peer rate is for 2015 and equates to ≤3.5 falls per 1,000 occupied bed days.

To prevent falls and to work towards zero harm from falls, SMHS patients are assessed for the risk of a fall and the potential to be harmed from falls:

  • on presentation to hospital
  • during their admission
  • when clinically indicated.

A combination of falls prevention and harm minimisation strategies are then used for those patients assessed as at risk of falling. These strategies form a falls prevention plan for the patient, and this is monitored regularly to ensure its effectiveness and appropriateness.

Patients and carers are also informed of the identified risks from falls and are encouraged to participate in the development of their falls prevention plan. Read more information about falls prevention (Healthy WA).

When a SMHS hospital’s falls rate does not meet the agreed benchmark a review is undertaken and an action plan is developed to address the issue/s.  

See how we measure up

The graph below shows the average falls rate across the SMHS hospitals.

Bar charts and other graphs are used to display data.  When comparing data it is important to exercise caution, as hospital activity varies between sites.

Table: Quarterly falls rate per 1,000 occupied bed days in SMHS hospitals, July–Sept 2017 to OctDec 2018

The overall falls rate for SMHS has averaged 4.05 falls per 1,000 occupied bed days from July to December 2017 and this dropped to 3.89 falls per 1000 occupied bed days for 2018. Whilst this rate is above the benchmark rate of ≤3.5 falls per 1,000 occupied bed days it is almost within 10 percent of the benchmark.

What do these figures show?
  • The overall falls rate for SMHS has averaged 4.05 falls per 1,000 occupied bed days from July to December 2017 and this dropped to 3.89 falls per 1000 occupied bed days for 2018.
  • Whilst this rate is above the benchmark rate of ≤3.5 falls per 1,000 occupied bed days it is almost within 10 percent of the benchmark.
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South Metropolitan Health Service